Some of the following forms are editable.
1. Save the form. 2. Type the information required. 3. Print. 4. Sign. 5. Fax to 902-491-8001.
IMPORTANT: Please ensure the claim number is on each page submitted to the WCB.
Work Capabilities Definitions
Tier 1 Forms
Form A - Intake Report
Form B - Initial Assessment
Form C - Progress Report
Form E - Physical Abilities Report
Service Provider Incident Form
Orebro Activity Screen Questionnaire
NOTE: If you require a Service Provider Account form to submit billing to WCB Nova Scotia for any Tier 1 physiotherapy or chiropractic services, please email us at SPM@wcb.ns.ca and a form will be forwarded to your clinic.
Other Forms - All Tiers
Release of Information
FCE Expectation Management Note
Case Conference Template
Tier 2 Assessment and Services Referral Form